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Medication-related Problems Series, Part 1- Untreated Medical Condition: Benign Prostatic Hyperplasia (BPH)

Posted Jun 10 2009 6:43pm
Elisabeth Gencorelli, PharmD Candidate
Anthony O'Brien, PharmD Candidate
University of Florida College of Pharmacy

Medication-Related Problems in seniors can cause, aggravate, or contribute to common and costly geriatric problems. A medication-related problem is an event or situation involving drug therapy that negatively interferes with a patient's health. One type of medication related problem that we will be covering in this article is known as an untreated condition. An untreated condition is when the patient has a medical condition that requires drug therapy but is not receiving a drug for that condition.
Benign prostatic hyperplasia (BPH) is a condition that affects about 50% of men between the ages of 51 and 60 and as much as 90% of men over the age of 80. The prostate is a walnut sized organ that surrounds the urethra. The main function of the prostate is to produce ejaculatory fluid. As a man ages the prostate often expands in size squeezing the urethra shut and causes urological problems. When this happens it is known as BPH. Common symptoms include a frequent and urgent need to urinate, trouble starting a stream, a weak stream, a small amount of urine each time you go, leaking or dribbling, and occasionally a small amount of blood in the urine. Men who are over the age of fifty and have a family history of BPH are at a higher risk of developing BPH.
Benign prostatic hyperplasia is usually diagnosed by a series of diagnostic tools. These include a digital rectal exam (DRE), a thorough medical history and a questionnaire called the AUA BPH Symptom Score Index. In addition the physician may do a urinalysis, an uroflowmetry, which measures the speed of the urine flow, a cytoscopy, a look into the urethra using a small flexible scope, or a PSA test to screen for prostate cancer, a more serious unrelated disease with overlapping symptoms. Once diagnosed, the physician and patient will discuss treatment options. Some treatment options include an alpha blocker such as tamsulosin, terazosin, alfuzosin, doxazosin, and prazosin. Alpha blockers work by blocker the receptor on the bladder and prostate responsible for contraction. Inhibition of this receptor causes the bladder and prostate to relax allowing for a normal urination. Another pharmacological option is the 5-alpha reductase inhibitors. These drugs inhibit the conversion of testosterone to DHT, a hormone that causes prostate hypertrophy. In some patients there are also surgical options such as TURP which involves cutting away a small portion of the prostate surrounding the urethra. Each patient should discuss the various treatment options with his physician and agree on a treatment.
Undiagnosed and untreated BPH can lead to more serious problems. Untreated BPH can lead to bladder damage, recurrent infections, blood in the urine and in some cases, kidney damage. Some drugs, both OTC and prescription, can exacerbate the symptoms of BPH and should be avoided if possible. Drugs that cause urinary retention such as opiates (morphine, codeine, etc), OTC sinus formulations containing pseudoephedrine and drugs with anticholinergic effects such as 1st generation antihistamines (Benadryl), tricyclic antidepressants (amitriptyline), and atropine can all exacerbate symptoms of BPH.
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